Who Is Qualified to Administer Botox Cosmetic?

Look at the photo on this page for a moment. Notice anything that looks a bit off? There it is! Now you see it: the dreaded joker eyebrows! This unappealing, telltale sign of bad Botox is easy to spot when only the outer half of someone’s eyebrows move as they are talking to you! It looks unnatural and almost comical, so surely this would be a rare occurrence, right? Wrong!

Contrary to what most people believe about Botox, it is a procedure that requires both technical skill and in-depth knowledge of facial muscle anatomy. Injectors who lack one or both can make you look like this poor gentleman in the photo because they simply don’t understand how to properly administer Botox.

Only licensed, medical professionals—Registered Nurses, Physician Assistants, Nurse Practitioners, and Physicians—are permitted to administer Botox injections. In California, our state regulations go one step further. If you are injected by anyone other than a physician, he or she must be at a practice that is under his/her or have a standardized procedure in place. This helps to ensure that a physician dictates the standard of care at that practice and that all medical personnel follows these standards when providing treatments for patients.

This explains who is legally allowed to provide Botox injections, but it still doesn’t answer the question of who is qualified to do them. This is a very important distinction for you to make because these really are two, very different things. We would even go as far as to say that legal qualification does not equate to good Botox injection technique and safety.

You might assume that you’d have better Botox results if you were injected by a physician rather than a nurse. We’d encourage you to challenge this line of thinking! It honestly doesn’t matter what the credentials behind an injector’s name are—it only matters how much knowledge and experience they have in performing your procedure.

So, when you’re deciding who you’d like to have performed your injections, make sure that you ask questions! Get a feel for their experience and qualifications. Look through some before and after photos. This type of information can tell you volumes about the kind of results you achieve – more so than the number of years that your injector went to school! Always remember that you are your own best advocate.


Now, back to our gentleman in the photo…THIS IS NOT A CELIBRE MEDICAL BOTOX PATIENT. However, he did come to us asking for help as he was unhappy with the results he received at another facility.

Let’s talk for a bit about just what went wrong with this fellow. “Joker eyebrows” happen when only the central/middle part of the forehead muscle (the frontalis) is relaxed with Botox. It is the muscle that is responsible for pulling the eyebrows up towards the hairline. The frontalis muscle is not shaped the same on every face, nor does it have the same pattern of contraction in every person.  His injector clearly did not recognize (or take the time to examine) his unique frontalis anatomy and contraction pattern. As a result, he was “under-treated” or not treated at all in the outer part of his frontalis (forehead) muscle. And to make matters worse, the middle part is so affected by Botox (i.e. relaxed), that it forces the outer/untreated part of his muscle to work even harder—making him look even more abnormal!

A qualified Botox injector is one that knows the correct dose of Botox to give, but also exactly where and how to inject it. If any of these variables are incorrect, an abnormal, unnatural, and unhappy-looking patient is the end result.

All of these skills are more dependent on the training and experience of the practitioner holding the syringe than they are of the letters behind their name. While a title does mean something, it doesn’t always mean instant qualification. Nowhere else in medicine is this truer than in cosmetic dermatology procedures. Take the time to vet your injector and learn about their background, training and history. It will save you time and money in addition to your sanity!

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